胰腺切除术后长期幸存者中胰腺形态学参数，外分泌功能和营养状况的评估及其因果关系
Evaluation of pancreatic morphometric parameters, exocrine function, and nutritional status and their causal relationships in long-term survivors following pancreatectomy
影响因子:2.70000
分区:医学2区 / 外科2区
发表日期:2024 Oct
作者:
Hirofumi Ichida, Hiroshi Imamura, Atsushi Takahashi, Ryuji Yoshioka, Yoshihiro Mise, Yosuke Inoue, Yu Takahashi, Akio Saiura
摘要
接受胰腺切除术的患者有胰腺外分泌功能不全和营养不良的风险。但是，这些并发症的发生率和相关的风险因素尚未得到充分检查。 This study aimed to investigate the changes in pancreatic morphology, pancreatic exocrine function, and long-term nutritional status after pancreatectomy.We assessed the nutritional status, pancreatic morphologic parameters, and pancreatic exocrine function in patients undergoing pancreaticoduodenectomy and distal pancreatectomy.根据体重变化，体重指数和骨骼肌质量评估营养状况。测量了手术时胰腺实质质地，胰腺实质的残留体积和胰管直径。使用N-苯甲酰基-L-二苯基-P-氨基苯甲酸排泄测试以及脂肪炎和非酒精性脂肪性肝炎的临床征兆测量外分泌功能。然后，我们研究了潜在的因果关系。在19例（27％）和15例患者（21％）中诊断出中度和重度营养不良。大多数手术前营养不良的患者也被发现术后营养不良。胰腺切除术后大多数患者的体重和骨骼肌质量也减少了，即使从长远来看也是如此。在36例（51％）和25名患者（36％）和胰腺导管性腺癌，胰腺十二指肠切除术，胰腺扩张性导管扩张，低术前体重指数和胰腺外治级造成的耐药度年度中，分别在36例（51％）和25例（36％）中发现了亚临床和临床胰腺外分泌功能不全。营养不良。胰腺导管腺癌，扩张性胰管，胰十二指肠切除术，术前体重指数低和胰腺外分泌不足是术后营养不良的危险因素。
Abstract
Patients undergoing pancreatectomy are at risk for pancreatic exocrine insufficiency and malnutrition. However, the incidence of these complications and the associated risk factors have not been sufficiently examined. This study aimed to investigate the changes in pancreatic morphology, pancreatic exocrine function, and long-term nutritional status after pancreatectomy.We assessed the nutritional status, pancreatic morphologic parameters, and pancreatic exocrine function in patients undergoing pancreaticoduodenectomy and distal pancreatectomy. Nutritional status was evaluated on the basis of body weight change, body mass index, and skeletal muscle mass. Pancreatic parenchymal texture at the time of surgery, remnant volume of the pancreatic parenchyma, and diameter of the pancreatic duct were measured. Exocrine function was measured using the N-benzoyl-L-tyrosyl-p-aminobenzoic acid excretion test and the clinical signs of steatorrhea and nonalcoholic steatohepatitis. We then investigated potential causal relationships.Seventy patients were included in the study. Moderate and severe malnutrition were diagnosed in 19 (27%) and 15 patients (21%), respectively. Most patients with malnutrition before surgery were also found to be malnourished postoperatively. Body weight and skeletal muscle mass decreased after pancreatectomy in most patients, even in the longer term. Subclinical and clinical pancreatic exocrine insufficiency was found in 36 (51%) and 25 patients (36%), respectively, and pancreatic ductal adenocarcinoma, pancreaticoduodenectomy, dilated pancreatic duct, low preoperative body mass index, and pancreatic exocrine insufficiency grade were found to contribute to postoperative malnutrition.Pancreatic ductal adenocarcinoma, dilated pancreatic duct, pancreaticoduodenectomy, low preoperative body mass index, and pancreatic exocrine insufficiency were risk factors for postoperative malnutrition.